Comprehensive Overview Insights from 11 Experts on ICD-10 Challenges

 Erika Regulsky Tags: , , Practice Management

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When you think about the impact of ICD-10 on your medical practice’s bottom line, you have an urge to know what other practices say about ICD-10 impact and whether they are in a similar situation.

To find out we listed out voices of industry experts to know their situation and their strategy for ICD-10 transition.

They share their views below:

Claim for date of service before October 1st, 2015 denied for not using ICD-10 codes!

Linda Girgis

One of my billers spent three hours on-hold with an insurance company. When we do get through, the staff on the phone cannot give us clear or accurate answers. My biller called about a previously denied claim and was told that she needs to resubmit it using an ICD10 code. This is completely wrong because ICD10 does not apply to patients seen before the date of service of October 1, 2015. Those patients still fit under the ICD9 codes.

Linda Girgis, MD,  Family Physician, South River, N.J.

Coding errors will result in payment delays!

Stephen Jacobs

The implications of ICD 10 scenario would be financially devastating. Incorrectly coded claims will result in payment delays, rejections and very likely audits.



Stephen Jacobs,  HealthCare Recruiters International

What is the first big issue under ICD-10?

Laurie Johnson

The more specific codes, I70.211 (atherosclerosis of native arteries of extremities with intermittent claudication, right leg) and I70.212 (atherosclerosis of native arteries of extremities with intermittent claudication, left leg) are covered.

“This oversight will create increased procedures/tests that do not have medical necessity,” Johnson warned. “This oversight will also impact patients who will pay out-of-pocket or will refuse the test.”

According to Johnson other similar issues are expected to arise


Have a Clinical documentation improvement process!

Deborah Grider

I think that when physicians and coders use the ICD-10 codes on a daily basis, it will eventually become easier.

The goal during this transition period is to stay calm, and to keep a keen eye on coding, documentation, and revenue. If you don’t have a clinical documentation improvement (CDI) process in place, incorporate CDI into your organization quickly. Stay alert and resolve all issues as they arise immediately.

Remember that we are all in this together: hospitals, physicians, healthcare facilities, payers, vendors, and others. The next few months may be challenging, but with diligence and focus, we all will be up to the challenge.

Deborah Grider,  Blue Consulting Services

It’s going to be a human resource issue

Bryan Chalmers The hospitals that were already set up to go live last year, they’ve got to retrain staff,” Chalmers says. “Other hospitals that were maybe a little behind, they’ve still got to get the education out; they still have to be able to get the systems tested and in place, and that amount of workload on top of meaningful use – you’re just going to have a human resource issue.

Bryan Chalmers, Ivinson Memorial Hospital

Still a small part of the volume

Joshua Berman

RelayHealth saw about five million institutional claims pass through the clearinghouse. Only around 50,000, or .01 percent, of these claims were coded ICD-10.  As of October 5, the ICD-10 volume grew to approximately 4 percent  (or about one million claims) — still a small part of the volume. The jump on professional claims (physician billing) was more significant; increasing from 1 percent to 36 percent. In the same timeframe

Joshua Berman, RelayHealth

Aetna on ICD-10 Claims

Matthew Clyburn

Aetna will require providers to use ICD-10 coding for all transactions with an October 1, 2015 date of service and forward. While Medicare may be making advanced payments available if Part B Medicare contractors aren’t able to process claims within established time limits due to administrative issues, we don’t plan on taking such action. Based on results from our extensive provider testing, we’re confident that this won’t be necessary.

Matthew ClyburnAetna

Anthem will not reject Medicare part B FFS!

Gene Rodriguez

Anthem will adhere to the CMS/AMA Medicare Part B announcement released on July 6, 2015. Specifically, Anthem will not reject Medicare Part B Fee-For-Service claims that are coded with an ICD-10 within the correct family even if the correct level of specificity was not used.

The announcement applies to Medicare Part B FFS claims only. All claims, including Medicare Part B, must have a valid ICD-10 code for a date of service on or after Oct. 1, 2015.

Gene RodriguezAnthem

Cigna to follow the CMS claim submission guidelines!

Mark Slitt

A code will be invalid if it has not been coded to the full number of characters required. When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it will be acceptable to report the appropriate ‘unspecified’ code (for example, a diagnosis of pneumonia has been determined, but not the specified type). Cigna is following the CMS claim submission guidelines.

Mark Slitt, Cigna

Not a major Issue!

Mohammad Rafieetary

I have been gone for meetings this week—not much patient care but my clinical administrator says there are still issues in posting charges.

The EHR has responded that the issues with the ICD-10 codes were on the practice management side. Apparently all (my vendor’s) practice management system users are having this issue.

Mohammad Rafieetary, Charles Retina Institute

Time-management is the biggest pain!

Dr. Pamela Miller

I am expecting no problems, other than time management, with a full load of patients. It is a bit hard to remember to code each patient as I go along, but I am getting a bit better at it. I re-did our exam sheet to reflect an area for ICD-10 codes, to make it easier for my staff and for me to remember. What a pain to try and remember everything when my job is actually to take care of our patients, not spend time looking up codes, etc.

Dr. Pamela Miller, Optometric CE, Inc

Too early to draw a graph!

It would be pretty early to come to any conclusion, depending on the thoughts expressed by the healthcare professionals. We have to wait for a year to know the statistics. It would be interesting to see how commercial payers process the claims and what could be the denial rate. The biggest challenge for medical staff would be time management.

Physicians are curious to see how it impacts their revenue and patient care as these two might be  a decision making factors.

11 Expert voices on the biggest challenges of ICD-10
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11 Expert voices on the biggest challenges of ICD-10
When you think about the impact of ICD-10 on your medical practice's bottom line, you have an urge to know what other practices say about ICD-10 impact.
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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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